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BE PREPARED FOR OBAMACARE

On Oct. 1, the much-talked-about federal Health Insurance Marketplace, part of the Affordable Care Act's mandate requiring all Americans to have health coverage, is expected to open online. For the next four days, the Tribune will focus on what this significant aspect of the controversial law means to Tampa Bay-area residents.

A companion special report is available online at TBO.com/health, where you can ask your own questions at the Tribune's Health Care Q&A.

TAMPA — It’s been a momentous year for Taylor Dame.

In May, the 23-year-old got married. And this month, he became general manager of the Little Greek Restaurant in Westshore Plaza. Dame’s current good fortune is tempered a bit, however, by uncertainty about the future.

His job is solid and steady. But like a lot of small restaurant gigs, it doesn’t provide health insurance. And starting Jan. 1, Dame knows that he and millions of other uninsured Americans will have to have medical coverage or face a financial penalty from the government.

Dame says he and his wife, Sara, already pay plenty of bills: rent, two cars, cellphones. And the couple really wants to start saving for bigger things, like buying their own home. It’s already a stretch with his $25,000 annual salary and his wife’s two jobs; it’s hard to imagine adding monthly health care premiums to the budget.

“Until I get financially stable, I don’t know if I can do it,” said Dame, who is healthy and hasn’t been to a doctor in several years. “It’s pretty much a money issue.”

This fall, Dame, his wife and more than 495,000 other uninsured Tampa-area residents must make some tough decisions. Do they enroll in the online Healthcare Marketplace, where subsidies may help offset the cost of a monthly premium? Or do they continue to go without coverage and risk financial penalties or, worse, a medical catastrophe?

“I think the idea that everyone is going to be insured is not realistic,” said Kathy Santana, director of a volunteer-led free clinic at Metropolitan Ministries in Holiday.

Many of the people who visit the weekly clinic are the working poor, living with chronic health problems such as diabetes and hypertension, Santana said. They have jobs, mostly minimum wage with no benefits. Some race straight from work to the Tuesday night clinic, grabbing one of the seven slots available each week.

“It’s not that they want something for nothing,” said Santana, a hospital nurse who has volunteered at the clinic since its inception more than a decade ago. “It’s the idea of another (bill) looming over their head.”

An estimated 77 percent of Florida’s uninsured families have at least person working a full- or part-time job, Kaiser Family Foundation research shows. National numbers are nearly identical.

Supporters of the Affordable Care Act and its Jan. 1 mandate are scrambling to make sure these individuals sign up on the marketplace or exchange. The program’s website, www.healthcare.gov, provides side-by-side comparisons of commercial health plans for consumers, and allows them to choose from varying levels of coverage. Age, family size and tobacco use are key factors used to calculate costs.

Basic (bronze) coverage is the least expensive in terms of monthly premiums. Prices and services offered increase with each new tier (silver, gold and platinum).

Individuals who make between the poverty level — $11,490 — and 400 percent of poverty — $45,960 — are eligible for subsidies that will reduce their monthly premium costs.

But that flat monthly fee is just one cost associated with the new health insurance. Like any other commercial plan, participants in the exchange will have to worry about out-of-pocket expenses, such as the deductible and co-pays that vary with each plan.

In Florida, 11 commercial insurance companies have been approved to offer plans on the exchange, but actual consumer costs remain uncertain. As of last week, just 17 states and the District of Columbia had released the specific premium costs that will be offered on the exchange, which opens for business nationwide Oct. 1.

Florida is not on that list. Last month, the Florida Office of Insurance Regulation released “estimated” per-person premiums, compared to 2012 individual plans. The one-year bump in cost varied from 21 to 55 percent.

But the U.S. Department of Health and Human Services, which is administering the marketplace in Florida, disputes those estimates. The benefits offered in the plans in 2013 were not comparable to older rates. And rates will vary depending on how urban or rural your location is.

Brandon resident Elsie Adams wants to keep her chronic thyroid condition in check, but can’t afford insurance on the $400 a week she makes as a home health caretaker.

“The fact of the matter is not that I refuse insurance, but the fact is that I can’t afford it,” the 61-year-old said.

So Adams visits doctors at the Brandon Outreach Clinic, a nonprofit group that provides health care to uninsured adults with incomes above the poverty level. (A separate program, the Hillsborough County Health Care Plan, exists to serve uninsured adults living at or below poverty.)

Ballpark estimates that are available show that Adams would pay about $121 in monthly premiums for a second-tier silver plan. Basic bronze coverage would be free, according to estimates on the Kaiser Family Foundation’s Subsidy Calculator.

Adams, who said previous tries to get insurance would have cost her $180 a month, had hoped to get close to an $80 premium. She worked with her pharmacist to negotiate monthly prescription costs down to about $20, so she isn’t concerned about doing some pricing homework.

“I don’t mind paying, you know, as long as I can eat and cover my other expenses,” she said.

Adams, like many living with chronic health conditions, is deeply mired in navigating health care and its costs. However, the Affordable Care Act’s marketplace is targeting another demographic: the “young invincibles,” who are healthy, under 30 and spend little time or money going to the doctor.

Krista Ruiz, 29, pays the bills by working part-time at a call center and a Wendy’s fast food restaurant in Port Richey. Health is important, but care has to be affordable, she said.

“It depends on how expensive the health insurance is,” said Ruiz, who visits the Metropolitan Ministries clinic when she needs to see a doctor. “Or I will look for a (full-time) job that offers insurance.”

A lot of young adults who live paycheck to paycheck are skeptical about the real need for health insurance, said Ruiz and Dame, the Greek restaurant manager. “It’s more of a burden than a benefit, I think,” Dame said.

There will be financial penalties for people who fail to get insurance. In 2014, the fine will be $95 or 1 percent of annual income, whichever is greater, and will be assessed as part of the federal income tax process. The fee increases each year, up to $695 per person or 2.5 percent of income in 2016.

“I have a couple of friends who say they will just pay the fine because they can’t afford it,” Dame said. “I understand why.”

The penalty, or tax, is why a lot of people oppose the law, known as “Obamacare.” Political opponents aren’t the only ones who hate it, said Gibsonton resident Linda Pippenger, who is uninsured.

“I think it sucks,” said Pippenger, a patient at the Brandon Outreach Clinic. “I’d like to know how (the government) can force people to do it.”

Pippenger, 55, takes six different medications for chronic conditions such as high blood pressure and cholesterol. She and her husband live on $17,000 a year, budgeting just $100 a month to pay for doctors’ visits, car repairs or home maintenance.

The Kaiser calculator estimates Pippenger, a smoker, would pay about $297 a month for silver plan insurance on the Healthcare Marketplace. If she didn’t use tobacco, the monthly premium would cost $28 a month. That means the free Brandon clinic is likely how she will access health care in the future, she said.

“If I could afford it, I would get (insurance), but I can’t,” said Pippenger, who has suffered a mini-stroke and whose husband is disabled.

Health problems are often what lead families into poverty, said Karl Celestine, director of outreach services at Metropolitan Ministries in Tampa. Bills tied to a catastrophic injury or illness that leaves someone unable to work is behind 30 and 40 percent of all the cases coming to the charity, he said.

Ebony Simon, 29, came to Metropolitan Ministries this summer for a food voucher, not health care. But the only reason health care costs aren’t a source of worry for the Tampa mom is that she’s ignoring it. Bills tied to a recent weeklong stay at a Tampa hospital have gone unopened since she lost her job at a local call center.

“They sent me a couple of bills. But I can’t think about it,” Simon said. “I threw it away.”

Simon is a lot like many of the 6,400 people who asked Metropolitan Ministries for help in July, Celestine said. Food, clothing and shelter are priorities. Health — and health insurance — takes a back seat, he said. They’re willing to gamble.